NPIMap

Organization Active NPI

Southcentral Foundation

Doing business as Dental- Port Alsworth Clinic

  • Dental Clinic/Center
  • Port Alsworth, AK
National Provider Identifier
1114480167
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
SOUTHCENTRAL FOUNDATION
Doing business as
Dental- Port Alsworth Clinic
Practice address
1 Flight Line Rd
Port Alsworth, AK 99653-9801
Phone
(907) 781-2256
NPI assigned
Apr 8, 2019
Last updated
Aug 31, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHCENTRAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ronald Lee Olson
Title
Executive Vice President Finance
Phone
(907) 729-4939

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1 Flight Line Rd
Port Alsworth, AK 99653-9801

Mailing address

PO Box 35151
Seattle, WA 98124-5151

Other identifiers 1

IdentifierTypeStateIssuer
1695503MedicaidAK

Other names 1

  • Dental- Port Alsworth Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southcentral Foundation Opt103 organizations share this tax ID, including this one
Part of
Southcentral Foundation Opt

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693440000000",
    "number": "1114480167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35151",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981245151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 FLIGHT LINE RD",
            "city": "PORT ALSWORTH",
            "state": "AK",
            "postal_code": "996539801",
            "telephone_number": "907-781-2256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCENTRAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHCENTRAL FOUNDATION",
        "enumeration_date": "2019-04-08",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "907-729-4939"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1695503",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental- Port Alsworth Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Alsworth, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.